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ARCHBOLD.ORG
•
SPRING 2017
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illness. The test results were more consis-
tent with a large pulmonary embolism, a
blood clot in Tangela’s lung.
Tangela was immediately placed on
a cooling blanket—the intent to lower
her body temperature to a target rate
between 89.6 degrees and 93.2 degrees.
The protocol—known as medically
induced hypothermia—has proved to
help preserve brain function in patients
who have experienced compromised
blood flow to the brain.
Next, Archbold hospitalist Jeremy
Latimer, MD, admitted Tangela to the
hospital’s Intensive Care Unit (ICU), where
she was administered tPA (a clot-busting
medication).
“Tangela had a very rough first night,”
said Dr. Latimer. “Her immediate issue
was low blood pressure and low oxygen
levels. For nearly eight hours, her oxygen
levels remained in the 40s (a normal
oxygen level is 95 to 100). And despite
being maxed out on all the medications
available to raise her blood pressure,
Tangela’s systolic blood pressure never
got above 60 (a normal systolic blood
pressure is between 90 and 120).
To keep blood circulating through
her entire body, Tangela was given
14 liters of IV fluids. She also received
seven units of blood and a second
dose of tPA within her first 12 hours of
hospitalization.
By midnight, she was starting to show
signs of better oxygenation.
From bad to worse
However, a prolonged period of car-
diovascular collapse (shock) inevitably
caused Tangela’s next challenge—
complete kidney failure and severe lactic
acidosis (when body fluids contain too
much acid) that can damage all organs.
To combat the acidosis and help prevent
organ damage, Tangela was administered
sodium bicarbonate around the clock.
The next lifesaving measure, and also
the first point at which doctors felt there
was a legitimate chance of survival, was
when Tangela’s blood pressure had
improved enough to tolerate dialysis—
the process that “cleans” and removes
the excess acid from a patient’s blood.
Tangela began inpatient dialysis under
the care of nephrologist Merrill Hicks,
MD. But she remained in the Archbold
ICU for nearly a month, where she was
cared for by a team of nearly 20 different
medical specialists.
Though Tangela progressed amazingly
well, it was not a quick process.
“She suffered from around 10 different
problems that could have easily been
fatal—massive pulmonary embolism,
profound hypoxemic respiratory failure,
prolonged cardiogenic shock, severe
metabolic acidosis, aspiration pneumo-
nia, anuric kidney failure, retroperitoneal
hemorrhage, shock liver that led to
disseminated intravascular coagulation,
four separate cardiovascular arrests prior
to arrival and severe acute blood loss
anemia,” said Dr. Latimer.
But Tangela overcame each hurdle as
quickly as could be hoped for.
At the one-month mark, Tangela
was transferred to Archbold’s Inpatient
Rehabilitation program where she
worked with physical medicine phy-
sician Nicodemo Macri, MD, to regain
everyday function again.
“Tangela was dedicated and extremely
involved in her inpatient rehab pro-
gram,” said Dr. Macri. “She was determined
to have a full recovery. She had a great
healthcare team caring for her, and that
along with the support of her family and
friends allowed for optimal healing to
occur.”
After about three weeks in inpatient
rehab, Tangela was able to return home.
Physical therapists visited a few times
each week to help her regain form
and function. She continued dialysis
treatments three times each week at
Archbold’s outpatient dialysis facility
in Bainbridge. In February, Dr. Hicks
confirmed Tangela had regained kidney
function and no longer needed outpa-
tient dialysis.
Though Tangela isn’t able to return
to work just yet, she is very eager to be
back in the classroom.
Lifesaving heroes
“I cannot give enough thanks to the
doctors who played a role in my treat-
ment,” said Tangela. “I feel as though
they all communicated with each other
to come up with plans that were best for
me as an individual patient. They were all
knowledgeable in their areas of expertise
and took the time to communicate any
information they had with me and my
family. Many of the staff, including nurses,
nurse techs and doctors, went above and
beyond to make sure my needs, and my
family’s needs, were met. Archbold saved
my life, and for that we are very grateful.”
“It’s really unheard of what she went
through—most people would have
never even made it to the ED alive,”
said Dr. Latimer. “Everyone involved in
Tangela’s care provided something cru-
cial for her along the way.”
Dr. Hicks added, “The staff and the
great doctors who were there as soon as
she came through the ED truly saved this
woman’s life. I’m proud to be a part of
such an amazing team of specialists that
work together to provide the very best
care possible for our patients.”
“I cannot give enough
thanks to the doctors
who played a role in my
treatment.”
—Tangela Smiley-Corker